title: Evaluation of drinking patterns and their impact on alcohol-related aggression: a national survey of adolescent behaviours.
abstract: BACKGROUND
  Although there have been a wide range of epidemiological studies examining the impact of patterns of alcohol consumption among adolescents, there remains considerable variability in both defining these patterns and the ability to comprehensively evaluate their relationship to behavioural patterns. This study explores a new procedure for defining and evaluating drinking patterns and integrating well-established indicators. The composite measure is then used to estimate the impact of these patterns on alcohol-related aggressive behaviour among Italian adolescents.
  
  
  METHODS
  Data were collected as part of the 2011 European School Survey Project on Alcohol and other Drugs (ESPAD). A national sample of 14,199 students aged 15-19 years was collected using an anonymous, self-administered questionnaire completed in a classroom setting. Drinking patterns were established using principal component analysis. Alcohol-related aggression was analysed as to its relationship to patterns of drinking, behaviour of friends towards alcohol use, substance use/abuse, school performance, family relationships and leisure activities.
  
  
  RESULTS
  Several specific drinking patterns were identified: "Drinking to Excess" (DE), "Drinking with Intoxication" (DI) and "Drinking but Not to Excess" (DNE). A higher percentage of males were involved in alcohol-related aggression compared with females. In males, the DE and DI patterns significantly increased the likelihood of alcohol-related aggression, whereas the DNE pattern was negatively associated. Similar results were found in females, although the DI pattern was not significantly associated with alcohol-related aggression. Overall, cigarette smoking, illegal drug use, truancy, limited parental monitoring, frequent evenings spent outside of the home and peer influence associated strongly with alcohol-related aggression.
  
  
  CONCLUSIONS
  Our findings suggest that drinking patterns, as uniquely monitored with an integrated metric, can: 1) explain drinking habits better than commonly used indicators of alcohol use and 2) provide a better understanding of behavioural risks such as alcohol-related aggression. Environmental background also appears to strongly associate with this type of aggressive behaviour.
authors.affiliation: Institute of Clinical Physiology, National Research Council (IFC-CNR), Via Moruzzi, 1, 56124 Pisa, Italy. sabrina.molinaro@ifc.cnr.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Siciliano
authors.forename: Lorena
authors.initials: L
authors.lastname: Mezzasalma
authors.forename: Valentina
authors.initials: V
authors.lastname: Lorenzoni
authors.forename: Stefania
authors.initials: S
authors.lastname: Pieroni
authors.forename: Sabrina
authors.initials: S
authors.lastname: Molinaro
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D016497:Adolescent Health Services; D000374:Aggression; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D012574:Schools; D013334:Students / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult